If Breast Cancer Comes Back

If breast cancer comes
back, it may return in the
same place. This is called a
recurrence, because it is not a new cancer.
But a recurrence can also appear in
a place not directly related to the first
breast cancer. This is called a metastasis,
and if cancer is detected in several areas,
these are called metastases. If breast
cancer comes back, it tends to show up
in specific areas of the body: the breast
or the area where the breast used to be,
the chest wall, the lymph nodes, the
bones, the lungs or around the lungs,
the liver, or the brain.

Cancers from other parts of the body
rarely spread to the breast or the chest
wall. If you have a tumor in your lymph
nodes, lungs, liver, bones, or brain, it
probably is a regrowth or recurrence of
the original breast cancer rather than a
new and different cancer. In other words,
if you had breast cancer and you now
have cancer in your bones, liver, or other
places, it’s probably not bone or liver
cancer, but breast cancer that has spread
to the bones or the liver. This is important
because breast cancer – even when it has
spread – is usually more treatable than
a cancer that starts in the bones or liver.

The return of breast cancer can be especially shocking if you have
passed the five-years-since-diagnosis mark.

Breast cancer that returns in other
parts of the body is invasive cancer.
However, cancer that comes back in the
breast after surgery or radiation therapy
can be either non-invasive or invasive.

If you have developed a cancer in the
opposite breast from the one that was
originally treated, it’s probably not a
recurrence. Most cancers that develop
on the other side represent a new cancer
rather than a recurrence.
Breast cancer can return in three
general locations:

Local, in the breast where it started
or in the skin and underlying tissues
where the breast used to be

Regional, in the lymph nodes next to
the breast

Metastatic, in another part of the body,
such as the lung, liver, bone, or brain,
or in lymph nodes far from the breast

If you have symptoms or tests that
suggest the cancer has returned, you
probably feel scared about the future.
It’s important to get help coping with
your fear of recurrence, and not try to
brave your way through it alone. You
also probably have many questions that
are very hard to ask: “How could this
happen after I worked so hard to do
everything right? I followed every doctor’s
recommendation. I ate all the right
foods and exercised regularly, even when
I wanted to skip it.”

It is hard to make sense of this. This
is particularly true if your original cancer
was only in the breast; your chest
X-ray, blood tests, and bone scan were
all normal; and your surgeon assured
you, “I got it all.” The return of breast
cancer can be especially shocking if
you have passed the five-years-sincediagnosis
mark.

This is where the limits of tests for
cancer become apparent. Tests can
detect a growth of one-half to one
centimeter or more. But they are not
sensitive enough to detect a collection
of single cancer cells. Cancer cells that
somehow escaped destruction the first
time can grow and spread. Eventually,
the tumor is big enough to see on an
X-ray, feel with your hand, or cause
symptoms.

A lot of anger comes with this crisis
– anger at the treatments you had and
your doctors for their inability to cure
you, anger at yourself for not beating
the disease, anger at your body for betraying
you yet again.

“Maybe I should have had the mastectomy.”
“Why did I stop tamoxifen?”
“How could I have waited so long when
I felt that lump?” All this second-guessing
gets you nowhere. But it’s not easy to
let it go. You’re trying to make sense
of something that makes no sense, pin
blame where there is none.

The best thing to do is to remind
yourself that recurrence is not a death
sentence. Breast cancer that returns to
just the breast or nearby lymph nodes
may be treated effectively with an excellent
outcome. Disease that has spread
to other parts of the body may be put in
long-term remission.

Also, keep in mind that you won’t
have the same experience with recurrent
or metastatic breast cancer as women
you know who had it years ago. New
treatments for recurring cancer have improved
survival. One large recent study
showed that over the past few decades,
women diagnosed with breast cancer
have had significantly improved survival.
And new treatments that have
been widely used only in the past few
years might mean even longer survival
in the years to come.

The likely course of the disease depends
on where and how extensively the
breast cancer has returned, the “personality”
of the cancer that has come back,
how long it’s been since you were last
treated for breast cancer, which cancer
treatments you’ve already had, any other
medical problems you have, and your
general health.

All of these facts need to be reviewed
carefully. Only then can you and your
doctors work out a plan of action.